For too many years the practitioners of Interventional Pain Management relied on steroids to manage chronic pain. Wanting to limit opioid use, they have tried to deal with pain in a more problem focused way by injecting the problematic areas with steroids. Epidural steroid injections, steroid joint injections, nerve blocks using steroids. Steroids, steroids, steroids. What could go wrong? Quite a bit, it turns out. Several serious consequences have been blamed on too liberal use of injectable steroids. That shouldn’t have been surprising as doctors have known for many years that oral and IV steroids contribute to bone density loss (osteoporosis and fractures), joint destruction (via cartilage degradation and avascular necrosis), and immune compromise.   We have evidence that injecting steroids into joints within a year prior to a hip replacement increases the risk for a surgical injection by 37%. Epidural steroids increase the risk of spine fracture, a particular concern for post-menopausal women and heavy smokers, who already have a heightened risk of low bone density. Injectable steroids also depress the immune system. Certainly, steroids reduce inflammation so they can alleviate pain effectively for a time. However, they don’t ‘fix” the problem of chronic inflammation, cartilage loss, nerve compression, etc. They only provide a temporary reprieve from the pain.

At my practice, we help patients find safe ways to manage their pain. To the extent that they are indicated, we may recommend injections of platelet rich plasma (PRP), or bone marrow concentrate to reduce joint pain and trigger improvements in chronically inflamed or torn tendons. Both techniques are well-studied and can be quite effective in reducing pain and improving use of an injured area. 

For some patients the injury doesn’t lend itself to injection therapy.  Or, the recommended injections are ineffective. Spinal Cord Stimulation (SCS) Therapy offers hope to many of these patients.  

SCS uses micro currents to disrupt the flow of nerve impulses from the spinal cord to the brain where they are understood to be pain. Until they reach the brain, these nerve signals really don’t register as pain in your body. So, by interrupting them at the spine level we can reduce one’s perception of pain.  SCS technology has been around for decades but in the past 5 years it has improved to the point where it is more reliably effective. Even so, a several day trial of stimulation is required; it’s a big benefit to be able to “try before your buy.” If, during the SCS trial your pain and function improve, you may be a good candidate for a permanently implanted pulse generator, a small device implanted under the skin and connected to a thin lead that enters the epidural space. This is minimal surgery and generally isn’t precluded by serious medical conditions.

Some of the most successful patient scenarios involve those suffering from back and leg pain following spine surgery, or patients with Complex Regional Pain Syndrome involving the legs or feet. Patients who are poor spine surgery candidates often find SCS a satisfying option, giving them better control of their pain and a more active lifestyle.

If you think you may be a candidate for SCS therapy. Call Advanced PainCare and BioHealth Institute today at 717-791-2860.